# US 8,540,744 B2 · Tissue penetrating surgical device > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 8,540,744 B2 - Document ID: US8540744B2 - Status: Granted - Kind: B2 - Application number: 12/060,601 - Filed: 2008-04-01 - Published: 2009-10-01 - Granted: 2013-09-24 - Earliest claimed: 2008-04-01 - Assignees: Ethicon Endo-Surgery, Inc. - Applicants: James T. Spivey; David Stefanchik - Inventors: James T. Spivey; David Stefanchik - Web page: https://patentgrep.com/patent/US8540744B2 ## CPC - A61B 17/320016: {Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes (A61B10/0233, A61B17/29, A61B17/3207 take precedence)} - A61B 17/32002: {with continuously rotating, oscillating or reciprocating cutting instruments} - A61B 17/00234: {for minimally invasive surgery (A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)} - A61B 17/320758: {with a rotating cutting instrument, e.g. motor driven (A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002)} - A61B 2017/00278: {Transorgan operations, e.g. transgastric} - A61B 2017/00858: {high friction or non-slip} - A61B 2017/320044: {Blunt dissectors} - A61B 2217/005: with suction drainage system - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract Devices and methods are provided for penetrating tissue and/or effecting movement of devices relative to tissue. In general, a surgical instrument is provided having an at least partially fabric-covered distal tip that be used to at least partially penetrate tissue by contacting the tissue with the fabric and rotating the fabric to “drill” into the tissue. The surgical instrument can be configured for delivery proximate to tissue through a working channel of a delivery device and can include an elongate shaft having in its distal portion an end effector at least partially covered in fabric. The fabric, the end effector, and/or the shaft can rotate, thereby allowing at least the fabric to penetrate the tissue and, if sufficiently rotated, causing an opening to form in the tissue. The surgical instrument and/or the delivery device can be advanced through the opening. ## Claims ### Claim 1 A surgical method, comprising: advancing a delivery device through an orifice into a body in a minimally invasive surgical procedure; advancing an elongate surgical instrument through a working channel of the delivery device toward a tissue wall, the elongate surgical instrument including an elongate end effector extending along a longitudinal axis of the elongate surgical instrument and having a fabric material extending over substantially an entire length thereof; contacting the tissue wall with the fabric material; and rotating the fabric material about the longitudinal axis of the elongate surgical instrument to cause at least a portion of a distal portion of the elongate surgical instrument to at least partially penetrate the tissue wall and create a full thickness opening through the tissue wall; wherein the full thickness opening is not present in the tissue wall prior to rotating the fabric material to create the full thickness opening. ### Claim 2 (depends on 1) The method of claim 1, wherein manually rotating a proximal portion of the elongate surgical instrument causes rotation of the fabric material. ### Claim 3 (depends on 1) The method of claim 1, wherein the fabric material rotates with the distal portion of the elongate surgical instrument. ### Claim 4 (depends on 1) The method of claim 1, wherein the fabric material rotates independent of the distal portion of the elongate surgical instrument. ### Claim 5 (depends on 1) The method of claim 1, further comprising advancing an endoscope through the opening. ### Claim 6 (depends on 1) The method of claim 1, further comprising allowing the tissue penetration to be viewed with a visualization device positioned within the distal portion of the elongate surgical instrument. ### Claim 7 (depends on 6) The method of claim 6, wherein the visualization device is positioned within a lumen extending through the elongate surgical instrument. ### Claim 8 (depends on 7) The method of claim 7, wherein the visualization device views the tissue penetration through an opening formed in the distal tip of the elongate surgical instrument. ### Claim 9 (depends on 1) The method of claim 1, wherein the distal portion is in the shape of a truncated cone. ### Claim 10 (depends on 1) The method of claim 1, wherein the distal portion tapers toward its distal end. ### Claim 11 (depends on 1) The method of claim 1, wherein the distal portion is substantially cylindrical. ### Claim 12 (depends on 1) The method of claim 1, wherein the delivery device is an endoscope. ### Claim 13 (depends on 1) The method of claim 1, wherein the elongate surgical instrument comprises a coiled shaft having a braided material over at least a portion of an outer surface of the coiled shaft. ### Claim 14 (depends on 1) The method of claim 1, wherein the fabric material comprises a mesh material. ### Claim 15 A surgical method, comprising: advancing a delivery device through an orifice into a body in a minimally invasive surgical procedure; advancing a surgical instrument through a working channel of the delivery device toward a wall of a body lumen, the surgical instrument including an elongate tissue engaging portion extending along a longitudinal axis of the surgical instrument and having a porous fabric extending over substantially an entire length thereof; positioning a distal end of the tissue engaging portion adjacent to the wall of the body lumen; and actuating the tissue engaging portion such that at least the porous fabric rotates about the longitudinal axis of the surgical instrument to advance at least a portion of the tissue engaging portion through the wall of the body lumen and create a full thickness opening through the wall of the body lumen; wherein the full thickness opening is not present in the wall of the body lumen prior to rotating the porous fabric to create the full thickness opening. ### Claim 16 (depends on 15) The method of claim 15, wherein the wall of the body lumen comprises the colon wall. ### Claim 17 (depends on 15) The method of claim 15, further comprising inserting the distal end of the surgical instrument into the body lumen prior to positioning the distal end of the surgical instrument adjacent to the wall of the body lumen. ### Claim 18 (depends on 15) The method of claim 15, wherein the delivery device comprises an endoscope. ### Claim 19 (depends on 15) The method of claim 15, wherein the tissue engaging portion is actuated with the distal end of the surgical instrument positioned adjacent to the wall on a first side of the wall, and wherein rotation of the fabric causes the full thickness opening to be formed in the wall to allow at least the portion of the tissue engaging portion to be advanced from the first side of the wall through the opening to a second, opposite side of the wall. ### Claim 20 A surgical method, comprising: advancing a delivery device through an orifice into a body in a minimally invasive surgical procedure; advancing an elongate surgical instrument having a longitudinal axis through a working channel of the delivery device, a distal end of the elongate surgical instrument including an elongate end effector extending along the longitudinal axis of the elongate surgical instrument and having a porous fabric positioned over substantially an entire length thereof; positioning the end effector of the elongate surgical instrument adjacent to a tissue wall; and spinning at least the end effector of the elongate surgical instrument about the longitudinal axis to drill the end effector of the elongate surgical instrument at least partially into the tissue wall and create a full thickness opening in the tissue wall; wherein the full thickness opening is not present in the tissue wall prior to spinning at least the distal end of the elongate surgical instrument to create the full thickness opening.